Dinh Thanh, Snyder Graham, Veves Aristidis
Beth Israel Deaconess Medical Center, Boston, MA, USA.
Int J Low Extrem Wounds. 2010 Mar;9(1):24-30. doi: 10.1177/1534734610363004.
Diabetic foot infections can be a challenge to diagnose, especially when osteomyelitis is in question. Evaluation of infection should involve a thorough examination of the extremity for clinical signs of infection along with appropriate laboratory and imaging studies. Laboratory markers of inflammation such as peripheral leukocyte count, erythrocyte sedimentation rate, C-reactive protein, and procalcitonin may provide useful information when diagnosing soft tissue and bone infection. However, laboratory markers alone should not be used to diagnose a diabetic foot infection as they are non-specific in nature. Imaging studies may also provide valuable clues regarding the presence of infection. Plain radiographs are a good initial screening tool as they are both inexpensive and easily accessible. However, their sensitivity in diagnosing osteomyelitis is poor. Thus, more advanced imaging such as radionuclide imaging and magnetic resonance imaging are warranted when osteomyelitis is suspected. Magnetic resonance imaging is presently considered the gold standard in diagnosing osteomyelitis, despite its wide variation in reported sensitivity and specificity. However, the significant cost of magnetic resonance imaging prevents its use as a screening tool. Collection of reliable microbiologic data is critical in making a diagnosis as well as for treatment of infection, especially when osteomyelitis is concerned. Deep swabs and transcutaneous bone biopsy are considered the ideal methods of obtaining the necessary information. Finally, monitoring treatment should also be performed with an eye towards both laboratory data and the clinical exam.
糖尿病足感染的诊断可能具有挑战性，尤其是在怀疑存在骨髓炎时。感染的评估应包括对肢体进行全面检查以寻找感染的临床体征，同时进行适当的实验室和影像学检查。炎症的实验室指标，如外周白细胞计数、红细胞沉降率、C反应蛋白和降钙素原，在诊断软组织和骨感染时可能提供有用信息。然而，仅靠实验室指标不能用于诊断糖尿病足感染，因为它们本质上是非特异性的。影像学检查也可能为感染的存在提供有价值的线索。普通X线片是一种很好的初始筛查工具，因为它们既便宜又容易获得。然而，它们诊断骨髓炎的敏感性较差。因此，当怀疑有骨髓炎时，需要进行更先进的影像学检查，如放射性核素成像和磁共振成像。尽管报道的磁共振成像敏感性和特异性差异很大，但目前它被认为是诊断骨髓炎的金标准。然而，磁共振成像的高昂费用使其无法用作筛查工具。收集可靠的微生物学数据对于诊断以及感染的治疗至关重要，尤其是在涉及骨髓炎时。深部拭子和经皮骨活检被认为是获取必要信息的理想方法。最后，治疗监测也应结合实验室数据和临床检查进行。
